Better Conversations Communication Partner Training for Progressive and Non-Progressive Aphasia: What Can We Learn From Intensive Conversation Groups?

backgroundBetter Conversations Communication Partner Training (CPT) is delivered to dyads comprising a person with a communication difficulty and a key communication partner (CP). Better Conversations focuses on individualised strategies to promote enjoyable and successful interactions. There is no research evidence about the optimal intensity or dosage for CPT. However, intensive comprehensive aphasia programmes are increasingly offered to deliver the high dose needed for effective intervention. This service improvement project aimed to explore the acceptability and outcomes from a BC Intensive Conversation Group for family dyads.

methodsWe developed separate intensive group programs for non-progressive aphasia and primary progressive aphasia (PPA). Each was delivered to four (non-progressive aphasia) or five (PPA) family dyads in a group for 8 days over 2 weeks (4 days face-to-face, four remote) in a university clinic. Intervention comprised understanding how conversation works, identifying individual dyad facilitators and barriers to conversation (using video feedback), practice (in the group and across dyads) of conversation strategies and psychological support. Participants were interviewed about their experiences and acceptability of the intervention. Outcomes post-treatment and at 3-month follow-up included goal attainment, conversation behaviours, communication confidence, participation and relationships. Data were analysed using descriptive statistics and content analysis.

resultsParticipants received a total of 26 h of Better Conversations CPT, delivered for 2.5-3 h per day, over 2 weeks (4 days a week). Participants valued the group format and preferred face-to-face sessions. Dosage was variably tolerated across the groups; people with PPA and their CPs reported the group was too long and intensive, while people with aphasia and their CPs reported intensity and length were acceptable. Of a total of 31 goals set, participants self-rated as having achieved 26 goals and rated no change on five goals. Outcome measures indicated increased confidence and participation across participants with PPA and non-progressive aphasia in both groups.

conclusionsThis service improvement project demonstrates that intensive conversation groups can be acceptable to participants with PwA, PwPPA and their CPs. Participants achieved their conversation goals and reported increased confidence and participation. Future research is required to explore the benefits of different dosages and intensities of CPT and the schedule of interventions over different disease trajectories. WHAT THIS PAPER ADDS: What is already known on the subject Better Conversations Communication Partner Training (CPT) supports people with communication difficulties and their key communication partners through individualised strategies. There is limited evidence on the optimal dosage or schedule for CPT, although intensive aphasia programs are increasingly used to deliver high-dose interventions. What this paper adds to the existing knowledge This service improvement project piloted an intensive group-based model of Better Conversations CPT for family dyads, including those with non-progressive aphasia and primary progressive aphasia (PPA). Intensive conversation groups (27 h over 2 weeks) were acceptable to participants with aphasia and their communication partners, who achieved most of their conversation goals and reported increased confidence and participation. Participants valued the group format and preferred face-to-face sessions, though tolerance for intensity varied: people with PPA found the program too long and intensive, while those with aphasia found it acceptable. What are the potential or clinical implications of this work? Intensive CPT is feasible to deliver and benefits family dyads, including those with non-progressive aphasia and primary progressive aphasia (PPA). Findings highlight the need for future research on tailoring dosage and scheduling across different conditions and disease trajectories.